| 500 E. Business Hwy 121 |
| Lewisville, TX 75057 FAX: 469-322-2668 |
| Sewell Marine |
| Individual Applicant Information |
| Primary Applicant |
| Co-applicant |
| Date: |
| First Name |
| Middle Name |
| Last Name |
| Suffix |
| Social Security Number |
| Birth Date |
| Driver’s License No. |
| State |
| Unmarried Married Separated |
| Home (check preferred contact) |
| Work Phone |
| Cell Phone |
| Email Address |
| ( ) – |
| ( ) – |
| ( ) – |
| Own Rent Family |
| Street Address (No P.O. Boxes) |
| State |
| Apt. |
| How Long? |
| City |
| State |
| Zip |
| County |
| yrs |
| Previous Residence Address (if less than 5 yrs at current) |
| City |
| State |
| Zip Code |
| How Long? |
| yrs |
| Employer |
| Title |
| Monthly Employment Income |
| Gross: |
| Net: |
| Street Address |
| City |
| State |
| Zip Code |
| How Long? |
| yrs |
| Previous Employer (if less than 5 yrs at current) |
| City |
| State |
| Zip Code |
| How Long? |
| yrs |
| Nearest Relative (not living with you) |
| Relationship |
| Street Address |
| City |
| State |
| Home Phone |
| Checking Acct. Bank Name |
| Savings Acct. Bank Name |
| Last boat financed with: |
| Monthly Payment |
| Mortgage / Landlord Name |
| Monthly Payment |
| Sources of Other Income (see * below) |
| Monthly Amount |
| Have you declared bankruptcy in the last 10 years? |
| Yes No |
| * Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. |
| Have you ever had any property repossessed? |
| Yes No |
| Authorization and Certification |
| Signature |
| The undersigned: (1) Makes all of the above representations, which are certified correct, for the purpose of securing credit; (2) Authorizes Russo Marine Financial Services, Inc. (“Russo”) and any prospective lender to gather whatever credit information and employment history is considers necessary and obtain credit reports periodically; (3) Authorizes Russo to use and share information with other entities that are related to it by common ownership or control; (4) Understands that Russo will retain this application whether or not it is approved, and that it is the applicant’s responsibility to notify the creditor of any changes of name, address, or employment; and, (5) Authorizes Russo to share this information with Global Marine Insurance Agency if an insurance quote is requested below. |
| X |
| Boat Information (complete on “primary application”) |
| Boat |
| Year |
| Make |
| Model |
| Length |
| Hull ID |
| New Used |
| Motor(s) |
| Year |
| Make |
| Model |
| HP |
| Type |
| New Used |
| Inboard I/O Outboard |
| Fuel |
| Serial Number Motor 1 |
| Serial Number Motor 2 |
| Seller |
| Gas Diesel |
| Private Broker Dealer |
| Name(s) |
| Sale |
| Registration and Titling |
| Agreed Sale Price |
| $ |
| Boat will be registered in the state of: |
| Address |
| Sales Tax (+) |
| $ |
| Current registration or Documentation #: |
| Title/Registration Fees (+) |
| $ |
| City, State, Zip |
| SUB-TOTAL = |
| $ |
| Is there a Lien? Yes No if yes, then: |
| Down Payment (-) |
| $ |
| Amount |
| $ |
| Day Phone |
| Bank |
| AMOUNT REQUESTED |
| $ |
| Acct # |
| Evening Phone |
| Phone |
| Please provide a no obligation Insurance Quote: |
| Yes No |